Dental, Vision, and Hearing Care with Medicare

Learn which dental, vision, and hearing care benefits you can get through Medicare and how to find coverage for the procedures it doesn't cover.

Every time you get paid, you contribute a part of your paycheck to the Medicare program. In theory, you shouldn't have to worry about medical coverage after you retire. Medicare should cover your needs.

While Medicare does provide insurance for many medical necessities, it doesn't cover most dental, vision, and hearing expenses.

In most cases, Medicare won't pay for items many senior citizens need as they get older such as:

Dentures

Hearing aids

Eyeglasses

Contacts

Read on to find out more about this program, what it does cover, and how to get the care you need.

Medicare 101

What exactly is Medicare? It is an insurance program signed into law in 1965 by President Lyndon Johnson. It was created because citizens over 65 were having a hard time finding adequate, affordable health insurance.

To qualify, you must:

Be 65 years or older and be a U.S. citizen. You need to have lived in the U.S. for at least five years, and paid for Medicare for 10 years or more or

Be under 65 years old and have received Social Security disability benefits or

Medicare is more complicated than most other health insurance plans. It has four parts:

Part A

This part of Medicare covers fees for:

Inpatient hospital care

Hospice care

Skilled nursing facilities

Home health services

Part B

Pays for physicians and services such as lab tests and physical therapy. Parts A and B make up what is called Original Medicare. You can also opt to receive Medicare a different way through private insurers (Part C)

Part C

Refers to another way you can receive Medicare. Part C allows private health insurers to administer Medicare health plans. These are called Medicare Advantage Plans.

According to Medicare.gov, there are several types you can choose from including:

Part D

The prescription portion of Medicare, Part D helps pay for prescription drugs. Consumers will likely pay a late fee if they don't sign up when Part D first becomes available to them.

Medicare was created to prevent people from ending up in the hospital and racking up large medical bills. Thus, it covers procedures deemed "medically necessary."

According to Medicare.gov, medically necessary refers to, "health care services needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine."

Most dental, vision, and hearing exams aren't "medically necessary." Since they are "routine" or "yearly checkups," Medicare covers very little of these expenses.

Unfortunately, these kind of procedures haven't been covered since the program was created. It seems unlikely they will be covered by Original Medicare anytime soon.

Dental

Those who opt for Original Medicare won't usually have dental coverage. That means no Medicare coverage for:

Routine cleanings

Fillings

Dentures

Extractions

There are a few exceptions. For instance, Original Medicare would cover dental work is if it was required for another procedure that it did cover. According to Medicare.gov, Part A might also pay for dental work if it is an emergency.

Some Advantage Plans will cover dental work, depending on the policy.

If you don't have dental coverage, consider looking into these options:

Marketplace

Your state might offer separate dental coverage through its marketplace. Check HealthCare.gov to see if you're eligible

Dental Schools

These schools offer dental services from dentists in training. Fees may vary depending on the student who is administering your care. For example, a procedure performed by a student working towards their DDS degree would cost less than an exam given by a dentist studying for an advanced specialty. Students would work under the supervision of a professor

Medicaid

People who qualify for Medicaid may be able to receive dental benefits. Coverage is limited in most states, but it is worth checking to see if you can get coverage

State Dental Association

Check your state's dental association website to find information about low-cost programs in your state. Many states have community centers that offer affordable dental care, usually based on income

Dental Lifeline Network

Vision

Medicare offers limited vision care. The following are not covered by Medicare:

Routine eye exams

Fitting exams

Contact lenses

Eyeglasses

There are some exceptions to this. If you have cataract surgery, Medicare Part B will cover one set of contact lenses or eyeglasses. It will also pay for routine eye exams if you have diabetes, in order to check for diabetic retinopathy.

Medicare Part B also includes some preventive care services like yearly glaucoma tests for high risk individuals. You'll have to pay 20 percent of the fee out of pocket plus the deductible, but Medicare will cover the rest.

You're considered high risk if you are:

Diabetic

Hispanic American and over 65 years old

African American and over 50 years old

Have a family history of glaucoma

Medicare will cover exams and tests for some other diseases such as macular degeneration and dry eye syndrome. This is because they are considered medically necessary. It also covers medically necessary surgery such as cataract surgery.

Those who choose a Medicare Advantage plan may have better luck finding coverage for regular eye exams and eyewear. These plans include at least as much coverage as you would receive in Parts A and B.

It may include additional benefits such as coverage for:

Routine eye exams

Eyeglasses

Contact lenses

Contact lens fitting exams

Each policy will differ on what it includes, so it's important to read each policy carefully.

Don't have Medicare Advantage or other vision benefits? One of the places below might offer an affordable vision care option:

Mission Cataract USA

Lions Clubs

This non-profit buys prescription eyeglasses for those people who are at or below the poverty line. In order to apply, a social service agency must send in an online application for you. This program doesn't pay for eye exams

Discounts from Memberships

Some group memberships offer discounts on contacts, eyeglasses, and eye exams. Examples include:

AAA

AARP

Costco

Medicaid

Benefits differ from state to state, but qualifying citizens may have coverage for eyeglasses and eye exams

Hearing

Routine hearing exams aren't covered under Medicare. But Medicare Part B will pay for diagnostic hearing and balance tests if a doctor requires one. If you receive a service covered by Part B, you'll pay for 20 percent of the procedure as well as a deductible.

Although many senior citizens need hearing aids, they aren't covered under Original Medicare. Like dental and eye care, an Advantage policy might include hearing coverage.

Medicaid

Veterans are able to get hearing aids through the VA if their hearing loss affects their daily lives. They may also get coverage for hearing aids if they lost their hearing while in the military

Sertoma

This nonprofit is dedicated to improve the lives of people who are affected by hearing loss. It provides national and state resources for those looking for hearing assistance programs and affordable hearing care

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